Most of us know from experience that tossing and turning at night means feeling rotten the next day. And many of us understand that there are long-term health consequences when we’re short-changed on sleep.

But recently I found out something new from a fascinating study on sleep and its effect on how fast postmenopausal women’s genes age – which is known as their “epigenetic age.”

In the study, postmenopausal women with 5 insomnia symptoms were nearly 2 years older biologically than similar women with no insomnia symptoms. The more insomnia symptoms — waking up at night, not being able to fall back asleep, disturbed sleep and so on — the greater the effect. If you’re sleeping only 6 hours a night, however, it doesn’t seem to increase your epigenetic age — so long as it’s restful sleep. And that, of course, is where a lot of us have trouble.

So what can we do about all this? I like to point out that the research shows that our genes are not entirely out of our control, and we can influence how they respond by taking better care of ourselves. For those of us who are done with menopause and may be having trouble sleeping, this means looking at ways we can improve our rest.

4 sleep tips to try

Keep a regular schedule. Your brain likes consistency, so go to bed by 11 and at the same regular hour each night and in a dark room.

Turn off the electronics! Computers, TVs, phones — they all are the enemy of sleep. Even a short duration of light shining in your eyes fools your brain into thinking it’s time to wake up. Shut down at least an hour before bedtime every night without fail, and put your phone on its charger in another room so you’re not tempted to look at it if you can’t sleep.

Are you at risk of losing up to 20% of your bone in the years around menopause? Women with accelerated bone loss – called “fast losers” in a new study – run a greater risk of developing osteoporosis and weaker bones than the average woman. The average woman only loses 8-10% of her bone mass during the three years around menopause.

This new study shows there’s an easy way to find out if you’re a “fast loser” of bone so you can take action to stop it.

Find out if you’re a “fast loser” of bone

Researchers focused on the use of the N-telopeptide crosslinks test — a urine test — to help identify women most at risk for greater and faster bone loss. As you lose bone, fragments of certain bone proteins show up in the urine; these are called N-telopeptides (NTx). A woman with more NTx protein fragments in her urine is likely undergoing more rapid bone loss, and thus at higher risk of excessive menopausal bone loss.

In the study, researchers looked at the NTx bone breakdown levels in some 500 early post-menopausal women who were within 1-2 years of having their final period. They found the following:

The higher the urinary NTx level, the faster the rate of bone loss across the menopausal transition. This makes sense: a higher rate of bone breakdown would likely translate into greater bone loss.

A urinary NTx level above 65 nM BCE/mM Cr was found to identify fast bone losers fairly well. To put this into context, the average premenopausal NTx level is 36 nM BCE/mM Cr, and I have generally found postmenopausal women with a 50 NTx level to be losing ½ to 1% of bone mass per year.

The association between early postmenopausal NTx and rate of bone loss was stronger at the spine than at the hip. This again makes sense, because the spine is metabolically active trabecular bone, which generally loses mass years before the hip does.

Furthermore, looking backwards, it was found that a high urinary NTx in perimenopause was also associated with a higher rate of bone loss during the menopause transition.

Menopausal bone loss is not spread evenly over the 10-year transitional period (5 years before a woman’s last period and 5 years after). Most bone loss occurs in the 3-year period starting 1 year before a woman’s last period and ending 2 years after her last period — known as “trans menopause.”

What does this research mean for you?

If you’re noticing symptoms of perimenopause, like irregular periods and hot flashes or if you underwent menopause recently (within a couple of years), a simple test of your urine NTx level can help you identify a tendency to excessive bone loss.

If you’re experiencing excessive bone loss, you can take steps to find out why this might be so and correct the situation. When I work with individual clients, this is exactly the sort of work I do with them.

And since you can’t really know when the year before your last period will occur until you actually have experienced your last period, it’s a good idea to get started right away on a strong Better Bones Program at the first signs of perimenopause.

Menopause is a time of many changes for women. But there’s no reason for one of them to be bone loss, osteoporosis, or increased fracture risk.

You have so many options to preserve your bone density — or even increase it — in the time around menopause.

Since most women experience accelerated bone loss in the first few years before and the first few years after their last period, these years are the most important ones for preventing excessive bone loss.

Let’s take a look at 6 ways you can take action.

Step 1: Give your bones the nutrition they need.

Good nutrition is a top priority in menopause. Eating well and taking supplements can reduce bone loss, and also decrease troubling menopause symptoms such as hot flashes, cravings and fatigue.

Step 2: Exercise to increase your muscle mass — and bone.

When you build muscle mass, you build bone — no matter what your age. As most of us have reached our peak muscle and bone mass at age 30, exercise is an ideal opportunity for building bone density and strength during the years leading up to and right after menopause.

Step 3: Protect your bones during any weight loss.

Many women find weight gain — especially around the middle — is a distressing symptom in menopause. But before you try to drop those pounds, know that age, weight loss and low weight are three important risk factors for low bone density. Any efforts to lose weight during menopause should include a plan to protect your bones.

Get your vitamin D levels tested and supplement with vitamin D and K as needed.

Include exercise in your plan to build both muscle and bone.

Step 4: Decrease inflammation and improve digestion.

Chronic inflammation can cause your bones to break down more quickly than they are being built up. And these effects of inflammation speed up during menopause.

One reason is the decline in levels of estrogen, which has a natural anti-inflammatory effect. Another is that as we age, free radicals and the effects of oxidative stress accumulate, which increases bone breakdown and lowers bone mineral density.

Tips for reducing inflammation:

Increase the “good bacteria” in your gut by eating fiber or yogurt. GI tract irritation may contribute to inflammation in your entire body.

Eat an alkaline diet and daily omega-3 fatty acids to help reduce inflammation.

Practice effective stress management

Step 5: Find ways to manage your stress level.

Stress harms bone through the release of cortisol, which in turn may lead to increased programmed cell death in our bone-building cells. Our bodies experience extra stress during the menopausal transition, so it’s important to incorporate calming routines into your life.

Tips to bring more calm into your life:

Meditation is a time-honored practice for inviting a sense of calm and relaxation into your body and your life.

Menopause and osteoporosis go hand in hand in the minds of many women — and unfortunately, many conventional healthcare practitioners too. But while menopause is a something we all go through, you should know that excessive bone loss isn’t.

Why you lose bone in menopause

Hormonal changes during menopause disrupt your body’s natural bone building process. Experts used to believe declining estrogen was the single “culprit” when it came to menopausal bone loss. After all, estrogen helps preserve calcium in the body and prevent bone breakdown. Recent thinking, however, recognizes that more is at play than just estrogen alone. As noted researcher Dr. Jerilynn Prior and many other experts now understand, the low progesterone levels common in perimenopause may also affect bone-building cells, disrupting the natural process of bone breakdown and repair. Interfering with this process can have a chilling effect on the health of your bones over time.

On average, a woman loses 10% of her bone mass during the menopause transition — an entirely normal part of the bone breakdown and build up process. After we reach our peak bone mass at age 30, we naturally experience more breaking down than building up. While most women have enough bone mass to handle this loss just fine, added risk factors like poor diet, family history and lifestyle can lead to excessive bone loss of up to 20%.

Recently, we’ve more accurately pinpointed the timing of menopausal bone loss. After looking at a 10-year timeframe around menopause, researchers found most bone loss occurred during one year before and two years after a woman’s last period. These three years are an important window of time for bone protection that you need to take advantage of.

You can reduce extra risk factors for bone loss in menopause

You can do a lot to preserve your bone density — and even increase it — in the years leading up to menopause and following it just by taking control of your risk factors. Since you don’t know exactly when your last period will take place, it’s best to get started now.

Your nutrient needs change in menopause. When estrogen levels decline, vitamin K function in bones also declines, including its role in the proper formation of bone protein which provides the framework for our bones. Most of us don’t get enough vitamin K, especially the most bone-supporting form, vitamin K2 as MK-7. Vitamin K2 MK-7 is found in aged cheeses and fermented foods, including the Japanese dish natto (fermented soy beans). Dark leafy vegetables such as kale, collards or spinach contain vitamin K1. For many, it’s so hard to get enough vitamin K through diet that supplementation is required.

Unfortunately, most of us are also chronically deficient in vitamin D, which your body needs to absorb calcium and limits bone breakdown. I recommend every woman have her vitamin D level tested at least yearly — it’s not very costly. Sun exposure boosts vitamin D production in the skin, but you may need supplements to reach the optimal blood levels of 50–60 ng/mL. The vitamin best D3 form is cholecalciferol.

Lose weight without losing bone.Weight gain — especially around the middle — can be a big problem for women in menopause. But certain weight loss efforts can harm bone. While we’re still analyzing the connection, I think that calorie restriction prevents women from getting enough nutrients in general. Weight loss trends such as eating diets high in animal protein and/or fat can also lead to a loss of calcium in the urine. If you’re going to lose weight, do so slowly (1-2 pounds a week) and include some form of weight-bearing exercise in the mix to foster bone strength.

Reduce physical and emotional stress. Our bodies are under enormous physical and emotional stress during hormonal transitions such as puberty and menopause. Stress causes us to release higher levels of the fight-or-flight hormone cortisol, which can lead to increased programmed cell death in bone-building cells. Over the years, excessive cortisol can weaken our bones. Because our bodies are particularly stressed during the menopausal transition, it’s critical to make time for stress reduction in our busy lives.

Manage hormonal fluctuations. Extreme hormonal fluctuations are not only bone-damaging, but they can also cause difficult menopause symptoms such as hot flashes, irritability and low energy. Many of the steps above will also help reduce extreme hormonal fluctuations. And, we’ve found that herbal remedies, including ashwagandha, red clover and wild yam are effective in restoring hormonal balance and reducing symptoms.

Remember that no matter what stage of life you are in, it is possible to improve your bone health naturally. The most effective approach is to give your body the support it needs to take care of itself and continue to build bone — just as Nature intended.

One of my top 5 intentions this year is to improve natural options for women experiencing menopausal bone loss. The average woman loses 10% of her bone mass during the menopause transition, and I’ve even seen some women lose more than 20%.

A good place to start is by looking at how nutrient needs change with menopause and how a nutrient that we consume in only tiny amounts — vitamin K — has a big capacity to reduce menopausal bone loss. We’ve known for some time that higher vitamin K levels are associated with a large reduction in hip fracture risk (up to 65%), but now there are new discoveries in the vitamin K story:

The latest news on vitamin K, menopause and limiting bone loss

Our need for vitamin K increases with menopause. One of the early effects of declining estrogen is the impairment of vitamin K function in bones, which includes the proper formation of the bone protein known as “osteocalcin.”

Impairment of vitamin K function occurs well before a woman’s last period. This new finding sheds light on why a significant amount of menopausal transition bone loss occurs in the 1-2 years before the last period. The need for vitamin K increases as a woman enters perimenopause.

K2 as MK-7 significantly reduces bone loss during menopausal transition. This is the more potent, bacteria-derived form of vitamin K. Keep in mind that vitamin K2 as MK-7 not only protects bone, but it has been found to reduce the incidence of both heart disease and cancer.

How to get more vitamin K

Increase your intake of K2 as MK-7. Aged cheeses and foods like sauerkraut can contain some amount of MK7 with high amounts found in the Japanese fermented soy food known as “natto.” For those who don’t consume natto, achieving the target intake of 180 mcg/day is difficult and requires supplementation with MK-7.

As you near perimenopause, increase your intake of both plant-derived vitamin K1 known as (phylloquinone) Two cups of green leafy vegetables such as kale, collards, spinach, beets, turnip, or mustard greens will boost your K1 blood level substantially. Even high lettuce intake reduces hip fracture risk!

Swedish research now confirms what other research has suggested…menopause occurring before the age of 47 is linked to an increased risk of osteoporosis and fracture as women age.

Specifically, at age 77 56% of women who experienced an early menopause (average age of 42) had osteoporosis, while only 30% of those who went into menopause at age 47 or later had the diagnosis. Also, fracture incidence was higher among those entering menopause before age 47.

But before you throw your hands into the air in frustration, I encourage you to remember that the very first truth of The Better Bones Revolution Manifesto is “there is an intricate, interwoven fabric of life in the universe.” This means that while we as humans generally do our best to mess with natural things, there’s a vast intelligence and order to nature with a harmony in the way things develop and function. When we listen to this intelligence, we can harness the power of nature to heal!

In the case of this study, we see that our bodies do indeed provide powerful clues about what is going on inside us. Rather than feeling a bit hopeless, women can use early menopause as a stepped-up call to action to take the healing steps outlined in The Better Bones Revolution checklist:

• Develop an alkaline diet

• Supplement with all 20 key bone nutrients

• Exercise ½ to 1 hour each day

• Make a commitment to seek happiness and reduce worry

While the age at which we experience menopause may have complicated origins due to many factors, there’s plenty that we can do to build and maintain strong, healthy bones at any age. And remember, an increased risk is still not a guarantee that you’ll suffer from osteoporosis or a fracture – especially when there’s the opportunity to take action.

What do you think, does having more menopausal hot flashes and night sweats tell us anything about menopause transition bone loss? I always suspected that this was true, but had not seen long-term studies supporting this relationship. Now I can say that researchers have taken a serious look at this question and their answer is “yes,” just as I suspected. After eight years studying more than 2,000 women, Dr. C. Crandall and colleagues recently reported that menopausal hot flashes herald both lower bone density and a higher rate of bone breakdown.

First in 2009, they reported that premenopausal, perimenopausal, and postmenopausal women with hot flashes and night sweats had lower bone density than women without such symptoms. Then in 2010, using the same 2,000-plus subjects, these researchers found bone breakdown to be higher among perimenopausal and postmenopausal women experiencing hot flashes, even in the earliest menopausal transition stages.

This link between hot flashes and bone loss makes sense to me, particularly in light of the fact that we now understand the inflammatory nature of both hot flashes and osteoporosis. From a practical point of view, this reaffirms the importance of gaining and maintaining endocrine balance during the menopausal transition. At the Center for Better Bones, this begins with strengthening the adrenal glands and then moving on to a variety of natural approaches to smooth out the menopausal transition, thus reducing the incidence of menopausal symptoms. All this takes on new importance as it now appears that cooling hot flashes may well help reduce menopausal bone loss.

If you’re a woman “of a certain age,” you’ve probably already heard the fairy tale that women’s bones crumble at menopause. I’ve said many times that thin bones don’t have to be weak bones, and women with osteoporosis or osteopenia in midlife won’t necessarily have a high risk of fracture, but it’s still wise to look at your fracture risk factors — including bone loss — and take action. The question is, how would a woman approaching menopause (but not yet past it) find out if she’s losing bone at a rapid pace, which could be a red flag for heightened fracture risk after menopause?

We know from research that the rate of bone breakdown as measured by markers of bone resorption such as the NTx test correlates with rate of bone loss in menopausal women. But are these markers of bone resorption helpful in predicting which perimenopausal women might fracture later in life? A new study from the University of Pittsburgh suggests this might be the case.

Looking at 2,406 premenopausal women over a period of 7.6 years, researcher Dr. Jane Cauley and colleagues found that women who had NTx levels above the median at any of the yearly clinic visits had a statistically significant (55%) increase in fracture risk within the 7.6 years of the study. So a higher-than-average rate of bone breakdown even several years before menopause could well weaken bone. From my work here at the Center for Better Bones, I find it is wise to look at markers of bone resorption well before menopause. As we now know, bone loss begins in the late 20s and early 30s and, given our current lifestyle, accelerated bone breakdown can occur much earlier than commonly recognized.

If you are a woman approaching menopause — or even younger! — and have a family history of osteoporosis or other risk factors, consider taking our Fracture Risk & Bone Health Profile to determine the basis of your osteoporosis risk. Then, look into getting an NTx test to see whether you have higher than the average bone turnover — and if you do, consider taking steps to alkalize your diet, reduce stress, and get bone-building exercise as a way of addressing the concern before it becomes a real problem. (You can look at my article about stopping bone loss in menopause for more ideas.)

It’s long been held that menopause is a time of rapid bone loss. This oft-cited generalization has now been carefully researched, and it appears that on average, women in the US and Canada lose about 8-9% of their bone mass in the few years just before and just after their last period. Some women, however, lose up to 20% of their bone mass, as I have seen at the Center for Better Bones.

I find that the trick to avoiding osteoporosis is to limit this “menopause transition bone loss” as much as possible. Let me tell you of Lynn’s case and why I think she did a good job halting this transitional bone loss.

Lynn is an athletic, weight-conscious, and very busy executive. She experienced her last period in 2005, and we began working on her bone health in 2007. By that time, she was two years into menopause and her bone density tests showed she’d already lost 4.3% of bone in her hip and nearly 7% in her spine during the two years before her last period and the first two years after it. Even though she had exercised regularly and taken calcium, she still experienced typical menopausal bone loss. Yet, you could say she was doing better than many other women, as she is petite and thin, and as a rule, women under around 125 lbs lose more bone during menopause than their heavier counterparts.

In 2007, two years into menopause, Lynn began the full Better Bones, Better Body® approach. She used the 20 key bone nutrients, reduced her anti-nutrients, stress, and toxic burden, kept up the strength training, and started incorporating our Alkaline for Life® diet into her routine. She also asked her doctor for several tests to make sure there were no hidden medical causes of her bone loss.

Three years later, in early 2010, her new bone density shows slight gains in hip bone density and a stabilization of spinal bone density. Lynn is now five years post menopause; she feels good, is strong, and has stable bone density. Furthermore, even though she began her Better Bones Program two years after menopause, and even though she is petite, Lynn was able to significantly limit her potential menopausal transition bone loss.

I often tell clients that it’s never too late to rebuild bone that you’ve already lost. Lynn is in one of the highest-risk groups for osteoporosis — a menopausal woman of thin build who has a high stress load — but if she could do it, so can you. You don’t have to do it all at once — even a few changes can help. The way to start is to learn about what your bones need to be healthy — and then give it to them! I discuss this more in my article on capturing the innate healing process.